Tuesday, January 22, 2008

Or something even more intimate. The Polish government have decided to have a ‘White Summit’ where government, president, medical profession and unions all get round a table and talk about stuff.

The health service is short of doctors, who, like nurses, earn a pittance. Strikes and threats of strikes are the norm. Some of the often crumbling hospitals are a health risk to anyone unlucky enough to be sick in one of them. The sector needs some radical surgery and intensive care. The government may have to administer some bitter pills (and other pharmaceutical metaphors). It needs the kiss of life, but all the health service gets is a talking shop and another opportunity for Tusk and President Kaczynski to get at each other’s throats. It’s another case of this government looking like it really hasn’t a clue what to do. So better set up a commission, a round table, a summit. I think they are just passing the buck.

Personally, I go private

Usually. Today, however, I had to go to the state works doctor to get a sick note and medicine for my chest infection. When I turned up and said to the nurse, whose head appeared through a square hole in the middle of a wall, that I needed to be seen, the doctor – a miserable, toad-like individual – initially didn’t want to see me. I think I was keeping him from his private clinic duty – the only way a doctor can stay in the profession is to do private work.

“But I have a contract with this organization, I pay social insurance and I am sick. I want to see a doctor. Oh, and I want some antibiotics, too.”

I always self diagnose. It seems to annoy doctors – which is fun.

Grudgingly, he relented: “Get his card and tell him to wait,” I heard him tell nursey.

So I waited. And then, I waited a bit more. I read some of the drug company flyers hanging around the place. And then I did some more waiting. I paced around the little waiting room, all the while waiting some more. I went outside the waiting room and down the corridor - but even there, I was still waiting.

I went back to the hole in the wall, just to give me something to do while I waited. The nurse hadn’t even bothered to get my ‘card’ yet.

“Can I have my card”?

No I couldn’t, because I didn’t have a card, because I had never been to see the doctor there before.

“And you can’t see the doctor without a card.”

“So could we…make a card?”

She got out a card. “Pesel?” It's a number and I don't actually know it.

“If you don’t have a number then you can’t have a card. And if you don’t have a card then you can’t see the doctor,” she said triumphantly.

I completely lost my temper - I am sick, after all - and ripped up the half filled out ‘card’ (very dramatically) and stormed out the door.

What have you gotta do in this place to get to see a doctor? So I went private.

In the LIM clinic in the centre of Warsaw, about seven rather nicely dressed receptionists are waiting to help with every need, as long as it is medical. They fill out the cards for you as if they were honoured to have the opportunity. They smile and talk about the weather. They then assign you a doctor. They give you a clinic number and say: “Room 9 and that will be 80 zloty, please.”

I waited outside No.9 for five minutes, sitting next to a man whose heal on his foot appeared to be pointing forwards, with his toes pointing backwards. Nasty. And then the doctor called me in.

She was nice but did what all Polish doctors do. They diagnose you, and then they write out a list of medicines and supplements as long as the Magna Carta. And the cost of the anti-biotics (yup, I got them) plus nose decongestant, chest decongestant, calcium (they always prescribe calcium for everything) something to counteract the effects on the stomach of the anti-biotics you are taking, anti-cold remedy….comes to the total planned Polish health service expenditure for 2008.

Are doctors on the make with drug companies, or what?

I would like to go to only state doctors in a state health service. But until they get serious, fund the thing properly, get rid of the inefficiency and corruption, I’m going private.

964 comments:

I have gone private for 8 years and it is the only way to go. We use Medicover and it is the best. Monthly fee is decent and the quality of care is topnotch.

The problem in Poland is that not one person in Govt. seems to have a clue as to what to do. This will be the Achilles heal of PO (unfortunately as I like them. They have inherited a systemic problem that has festered for decades and it cannot be fixed overnight. Simply throwing money at salaries will not be the answer. With that said, the medical personnel are in dire need of salary increases.

Given the inept nature of the Govt. staffers in the Health Ministry and their lack of vision the only intelligent way to deal with the overall situation, in my opinion, is to hire one of the large Intl. consulting groups to develop a business/financial/social strategy to make the service and sector healthy so to speak over a period of say, 10 years. In addition, people as part of a strategic look need to see the big picture and all of its constituent parts. For example, medical students get a free education, then they learn English (for example) and leave Poland for greener pastures. So the public foots the bill for education and then loses the investment - smart huh? Students should as part of an overall overhaul be required to take out 'loans' for their education and be required to work in the profession in Poland for X number of years to 'repay' the loan (with good salaries) If they choose to leave Poland before that period, the loan becomes due and payable.

There are certainly more things to discuss and it takes more than a blog forum but it should be obvious to all that there is a collision facing the country and the health service is just the beginning.

There is a similar square hole in the wall down here in Kraków and the very same message comes out of it:

Not a Polish citizen > No PESEL = No entitlement to treatment / registration

In fact (as far as I'm aware) that is simply not true and EU citizens paying social security contributions in Poland should be entitled to register immediately with a public health service doctor in Poland without a PESEL (but obvously on presentation of proof of ZUS).

I should probaly add that my comment above seems to apply to foreign nationals of EU member states residing in Poland and trying to register with a doctor here with a view to getting treatment.

Tourists from other EU countries should still be able to get treatment in Poland on a pretty walk-up basis on presentation of their E111 or whatever it is now called (that is if the Polish doctors / nurses / square hole in the wall even knows what it is / bothers to request it...). That is at least how I've seen it work in the past (pretty smoothly in fact)....

Re. revenge, please watch The Count of Monte Cristo (w/Depardieu) and pay attention to the counsel of the Count's assistant (different than in the book).

And stop smoking once and for all if you haven't already because it is going to make your respiratory system more and more susceptible to infections and you have better things to spend your money on than tobacco and health care bills. Not to mention whatever subsidies the public pays.

Finally, isn't the below from your radio website an off-handed way of saying fuck you to the nurses out on strike?

"Former Health Minister Zbigniew Religa expressed doubts that 'White Summit' meetings will bring substantial results. Speaking to Polish Radio today Religa said that instead of talking about the reform of the whole sector focus should be put on finding a solution to a particular problem, e.g. doctors’ salaries."

If that is what Religa said he is totally missing the point. He may be a gifted surgeon but putting him in as health minister by the last government was like making a great car mechanic the president of Porsche - let's get real, these folks have no vision whatsoever. See the post above by anon. 9:17pm yesterday.

As they say in Polish it would be a balagan doing that. If you really look at it, the reason, in a democratic society (which Poland has been since 1989)is that the voters are too apathetic to drive change. The people in Poland have suffered through this horrible public crisis for decades and if experience is a teacher, if the govt. does not acknowledge that it does not have the answers and go external for a professional view this problem will not go away and we will be having this same conversation for years to come. If that is what turns out, the PO government will see this as their achilies (sp) heel as will future governments. Who will suffer? The entire society from the users of the service to the service providers themselves.

The governments over the last few years - any disinterested observer would have to conclude - have known exactly what they were doing: creating a two-tiered health service by neglecting the public sector and practically forcing you, Beatroot, into the arms of private enterprise. PiS are suggesting raising the health insurance contribution to a hail of media abuse - some of it deserved, since when they were in power they did no such thing, neglecting health care even more than PO.

When I lived in Poland some 10 years ago I remember a student saying something along the lines of "I go private becasue the public health service is too expensive." Isn't it free? I asked to which she replied that it was supposed to be free but you needed to give the doctor a gift. Here we were talking about her child's operation. A gift - a nice bottle of malt whiskey perhaps? My father was a doctor in Britian and often was offered (but did not accept) such lubricants. 'No it has to be cash in an envelope' she replied. Is this perhaps where the Beatroot went wrong?Now that I am living in the USA I have an interesting phenomenon to report. Our expereince here of private health care - for which we pay a lot more that 80 zl - is much closer to the public health doctor story than the story with the nine lovely nurses. I have expereinced the hole in the wall thing - especially when we went for our green card exam - which mainly seemed to involve looking up our noses (I know not what for!) and charging us 300 bucks. I have had to make 300 calls to get my child a hearing exam only to be told there is fluid and I have to see someone else which involves making another 300 bucks. And each time you see a doctor they send you 5 bills each time with a slight correction so in the end you have no idea how much it cost you - other than alot.The health no-system here is as bad as the pubic service in the UK - probably not as bad as the public service in Poland but curiously not up to the standard of private care in Poland. I suspect that the lack of any public alternative makes it possible for the clinics and doctors offices here to be really really crap, rip you off royally and then smugly critise European (that's former Western European Sonia - Michael Moore's statistics are based on UK, France and Germany - not democracies recovering from transition) public health services based on the fact that people there aren't happy either!Bravo Beatroot for trying the public system.

And stop smoking once and for all if you haven't already because it is going to make your respiratory system more and more susceptible to infections and you have better things to spend your money on than tobacco and health care bills. Not to mention whatever subsidies the public pays.

I know, Geez. Every time I light one of the deliscious little tubes of joy I remind myself that I ama complete fucking idiot.

And you are right about religa. And maybe he has a point. Better paid doctors is crucial. And nurses. You pay peanuts, get monkeys wearing stethoscopes...

unonononon...

Wouldn't it be more sensible and democratic to have political parties and their candidates lay out respective plans and let the voters decide on the basis of who they vote for?

Completly agree.

anonif the govt. does not acknowledge that it does not have the answers and go external for a professional view this problem will not go away and we will be having this same conversation for years to come.

Of course a government should go for advice, but the choice is fundementally a political one - and that is about politics, not 'experts'.

I should make something clear. My girlfreind was very sick a few years ago, she went public, and it was fine. The 'bed side manner' was lacking, but the treatment, extensive, was OK.

But we learnt to play the system a little. Here is my advice. If you have a serious problem in Poland, go and see a consultant, a few times, in the private sector. Then find out which hospital he works in for the public sector, and then register as a patient there. He will know you and make sure you are treated OK.

I think that is the best way of getting the best out of doctors, without having to bribe them in Poland. And the people who bribe doctrs, directly, should be thrown in jail. Period.

Actually, you ain't fucking when you're smoking so try fucking more and indulging in less nicotine-induced idiocy. Sex is much better than stinky chewing gum or silly patches, doncha think? Your lady will be much happier on both counts and u will b 2. You can send your 80 zlots in the mail to me at...

Centrum LIM is awesome. My employer fully pays for coverage by CMLIM and I've used it a few times. Very, very nice.

One question, though, Beetroot: how have you managed to stay in Poland as long as you have without getting a residency card? Is it not required because you're British?

Since I don't have the luxury of being British I did have to register for a residency card, first based on the fact that I had a job. They initially refused to issue me a work/residency card based on the job offer but, with a lot of time and bitching and persistence they finally did. Shortly after that I was married so I got to go through the whole process again. The upside of being married, though, is that the residency card is based on the marriage, not a job, so switching employers is not a hassle.

Oh, and you get a PESEL number, too, on a really official-looking card. The border guards always seem impressed when they glanced at it for .2 seconds.

One experinece: We had to request a doctor house call for one of our kids lately from Lux-Med -- it was a Sunday, two doctors came to the flat (in an ambulance I think). They checked our kid, wrote a prescription and left -- the house call cost 160zl.They had a card machine, so I just used my debit card...I think that Lim center charged over 300zl for the same service.

hire one of the large Intl. consulting groups to develop a business/financial/social strategy to make the service and sector healthy so to speak over a period of say, 10 years.

Heh. You don't need idiots from Accenture to tell you that what the system needs is professional management and accountability. It's obvious. After all, if you are not paid by the number of patients treated, but salaried instead, it's in your best interest to do as little as possible.

The dirty secret is that the present system is good for everyone:

- doctors, because you pay them 80 zloty to get a flu treatment;

- drug companies, because the doctors will precribe their drugs for your flu;

- doctors (again), because although you can get the hospital treatment free, you have to bribe a doctor to be admitted;

- nurses and other secondary personnel, because they get a power trip from deciding if you can see a doctor or not;

- trade unions, because they get a political leverage on the government;

- Jurek Owsiak, because he can run his charity actions to give to hospitals the equipment (and said hospitals cannot later afford the personnel and consumables to use it);

- equipment manufacturers, who can sell their overpriced stuff to Owsiak.

BR's story would be much funnier if it went like this:

- BR goes to see a doctor in a state medical center;

- the registration lady does not let him through, since she cannot be disturbed with her coffee;

- he goes to a private one and pays 80 zloty;

- he sees a doctor, who is the same one as in the state center, but working on a second job.

And that was the time when if any doctor found a kid with a sore throat, that kid would go into the tonsil to have his tonsils and adenoids removed. All the ice cream you can eat was the common promise. Then you'd get the ice cream and scream coz it hurt so bad.

Also just so you know, nowadays it is not uncommon to spend about 1/2 hour on the phone in the US to get a doctor's appointment scheduled. And 1/2 hour waits in the office waiting for a scheduled appointment are typical.

And reading Opamp's note above, it seems like the only ones not getting their palms greased are the nurses and the trade unions. Leverage and a two zlot tip will get you a cup of coffee maybe?

First, pardon my purism:BR, "heal on his foot appeared" - is it good or bad? Anonymous copies you with: "Achilles heal of PO".

Secondly:'Kiss of life' is a nice way to express what? Has anyone suggested solutions? No? Why would we expect politicians to have bigger brains? Talks just get boiling down to: you gotta do [here goes the magic word:] something. Thinktanks exeunt. Tips and hints how to override the system follow. Until next summit, white or not.

Opamp - I see you have your head in the sand like most of the people in Poland when it comes to the health care system here.

It simply does not work, cannot work in it's present form and nobody in Govt. has any vision on how to make it work. If the Govt does not go to an outside source to get a vision, strategy and a tactical plan put together the system will not continue to fail, it will crash and burn like a plane falling from the sky nose down (it is called auguring in aviation parlance) And, yes, the 'idiots' as you call them are really the only way to accomplish a project of this magnitude and importance in Poland, others clearly to not have the experience, knowledge or skills to handle it, if they did it would have been taken care of by now. I guarantee you, that if they do not go outside, this problem will fester and we will be debating it next year, and the next year and so forth.

Anti - you are correct, experts do have differing positions.However, at the current time the Govt. lacks any coherent opinions or strategy. What needs to be done is for, believe it or not, a 1 page position paper to be developed by the Govt. and that serves as a road map for external resources to develop strategies and tactics. Typically a tender process is used to select external resources to ensure the best group gets the project.

All of the expatriates should be required to pay for their own medical care. You will just have less money to spend at the Salon.

Why should Polish citizens be burdened with the cost of your health care. The overall lesson about socialized medicine should have sunk into the head of a wiser man.

I must have imagined scores of Canadians opting out of their socialized health care in the streets of Northern Vermont. They were in St Albans Vermont parking in Doctors and Dentists offices on their way to buy Booze and smokes at the Beverage Mart even though it is two miles away.

I should also forget my coworkers going to Canadian dentists for cashcrossing the border the other way.I must also be imagining the daily horror stories on Montreal talk radio about a health care system that doesn't work and is costly.

Cuba also does offer low cost lobotomies for the true faithful.Some of you apologists seem to have allready taken advantage of this offer.

Not at all! I'm trying to understand how government-run (universal) health care under the old Communist system differs from the current system. It occurs to me that the current system is a polar opposite of the old system but one still has to “play the system” in order to have it work.

As an expatriate you sould pay private insurance, non citizens are not entitles to the same benefits in most countries.

For the simpleton Geez and all the other nitwits. The visa waiver program has nothing to do with politics. It is handed out to countries with a low percentage of people who overstay their B2 visas.The determination of this policy is not done at the political level.

Brad - I may be wrong but if you are paying taxes, have a work permit, have legal status and have the 'pesel' you are entitled to use the NFZ. I believe your monthly deduction for tax shows a payment to ZUS a portion of which is allocated to NFZ - check it and kindly post here whet you find, it would be interesting for me to see.

Strangely enough, that is how immigration policy is determined by the Republican Bush administration vis-a-vis Poland.

"Polish officials complain the criteria for granting visas are arbitrary and entirely subject to the whims of US consulate employees."

"Anecdotal reports in Poland suggest applicants should visit US consulates on Fridays, when employees are in good spirits ahead of the weekend and tend to approve more applications."

The embassies of six European Union states accredited to Washington joined forces this week to lobby for visa-free travel to the United States for their citizens, Poland's PAP news agency reported. The Washington DC embassies of the Czech Republic, Latvia, Lithuania, Romania, Slovakia and Poland signed a joint declaration saying a recent bill passed by the US Congress regarding visa restrictions "does not meet our expectations."

Why do you insist on arbitrarily discriminating against Poles after we have fought for your country in your dirty war for oil, Beakerkin?

We don't buy your lame and pathetic excuse that the 10% rejection rate is somehow automatically set. Nor do we accept how 26% of Polish visa applications are largely arbitrarily rejected at the whims of some anti-Polish jerks like you.

As stated before the countries placed on the visa waiver program are determined by a mathematical model.The mathematical model is based upon the probability that the residents of the country will become illegal aliens.

The rejection rates are determined by information on the application. The vast majority of the questionstend to be designed to determine who will become an illegal immigrant. There are also much smaller numbers of criminals rejected.

I never said a word about the rejection rate. The countries that are eligible for the visa waiver program are determined by the mathematical probability that the immigrant will become an illegal alien. Moreover, if any group is screwed by wacky immigration laws it is Philipinnos who are made to wait longer than any other nation despite our shared history.

Anti-Polish!!!!!! You must have me confused with a certain blog host who leaves his Salon atop Mount Olympus and throws down lightning bolts on Poles who think allowing people to immigrate with dangerous and costly communicable diseases are primitives.

Beakerkin, you obviously don't know the difference between your ass and the hole in your head.

Yes, you are anti-Polish! You are moreover opposed to the position of the Polish government regarding US visas. And then you deny that there is any such thing as anti-Polonism. And then you have the unmitigated gall to cast aspersions upon somebody who has chosen to live in Poland and who has chosen to live with a Polish woman. Not that you'd ever have the opportunity to make the latter choice. And you sure won't ever move your candy ass outside of where that silver spoon is most comfortable inside it.

There is no such thing as anti Polonism. People really do not run around talking about Polish cabals to run the planet. The subject is proof you are an ignoramus.

As far as the visa waiver program goes it is calculated by a mathematical number. There is zero link between political issues and the waiver program.

On to the more rational.

Roads are pretty much there and you are entitled to some police protection much like tourists. Health costs of non-citizens shouldnot be paid for by citizens. This should be your responsibility. As you are gainfully employed you should be able to pay the cost.

The part about Public TV is quite amusing. If it similar to US fare you should be required to pay not to watch it.

Non citizens do not have the rights and benefits of citizens. If you want those benefits you should be required to be a citizen.

What is the point of citizenry if you get the exact same rights and benefits as citizens.

GeezAnd that was the time when if any doctor found a kid with a sore throat, that kid would go into the tonsil to have his tonsils and adenoids removed. All the ice cream you can eat was the common promise.

It was exactly the same in UK, when I was small. I was terrified of getting tonsillitis just in case they might decide to stuff me in a hospital and start cutting bits – bits I was rather fond of – out from the place that nature had put them. It’s a slippery slope: in the US, someone told me, it is, or was, fashionable to remove…foreskins – even if you are not..you know…under a religious obligation to…

Funny where is your lecture to Geez about staying on topic. What does the Visa Waiver program have to do with the post? Moreover what is the link between it and Iraq. Obviously this is beyond the grasp of those making absurd remarks.

Health care is very expensive and nobody is advocating tossing people out of emergency rooms. Being a non resident citizen is not a right. It seems that many people forget that immigrants (non citizens) have duties as well.

in the US, someone told me, it is, or was, fashionable to remove…foreskins – even if you are not..you know…under a religious obligation to…..um…why?

>>>>

American ingenuity. This way when we rub our wallets, they turn into suitcases.

There once was a powerful emperor who needed a new chief Samurai. So he put up posters throughout the land saying he was searching for a new chief Samurai. But after 2 months, only 3 Samurai applied for the job, a Japanese, a Chinese, and Morris. So he interviewed all three.

The emperor first asked the Japanese to demonstrate why he should be his chief Samurai. The Japanese opened a little silver box and out flew a little fly. Whoosh went his sword and the fly dropped dead in two pieces. The emperor was impressed.

The emperor then asked the Chinese to demonstrate why he should be his chief Samurai. The Chinese opened a small pearl box and out flew a smaller fly. Whoosh, whoosh went his sword and the fly dropped dead in four pieces. The emperor was very impressed.

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What rights do the tax paying citizens have. Must they bear the costs of expensive drug treatments for people like Simon Mol.

There is a difference between treating a person in a car accident who is not a citizen and long term expensive communicable diseases like AIDS or drugs resistant TB. FYI American hospitals do treat illegal immigrants who do not pay.The cost is a serious problem in LA, NYC and Arizona. Even Fidel Castro requires cash payment up front.

Besides wages, various social benefits intended to ensure the life and health of workers and their families play a part here. The expenses involved in health care, especially in the case of accidents at work, demand that medical assistance should be easily available for workers, and that as far as possible it should be cheap or even free of charge.

The most important thing is that the person working away from his native land, whether as a permanent emigrant or as a seasonal worker, should not be placed at a disadvantage in comparison with the other workers in that society in the matter of working rights. Emigration in search of work must in no way become an opportunity for financial or social exploitation. As regards the work relationship, the same criteria should be applied to immigrant workers as to all other workers in the society concerned. The value of work should be measured by the same standard and not according to the difference in nationality, religion or race. For even greater reason the situation of constraint in which the emigrant may find himself should not be exploited.

You obviously have no knowledge about or respect for Catholicism when you compare those statements to Marxism. And your remarks are insulting to all Poles who have a deep reverence for Karol Wojtyla. Or are you sooooooooo ignorant, Beakerkin, that you do not even know JPII was Polish? Seems you've already struck water in that grave of yours... Hey, btw why don't you answer Beatroot's request to locate those statements in some Marxist text?

You obviously are learning disabled if you can not comprehend the Marxist substance. Pope John Paul did take some heat for pulling the plug on the Revolution Theology crap in Central America. The current Pope supposedly did the leg work.

It is a demented stretch of the imagination to call me anti Polish or anti Catholic. However, you do seem to qualify as demented.

I am well aware of the Pope Paul's nationality. However, I do not go to theologans, demented linguistichacks or hippo pea brain film makers for governmental policy issues. I also do not ask car mechanics about theology or accountants about botany. As someone familiar said something about render onto Ceaser ....

Lets see ask your friend to come out of the salon and define substance. Substance and quotes are quite different.

I really do think that Poland sucks. I (foolishly) was persuaded by a language school to come over and work for a year. I was promised a lot, but received little. Do I need a NIP number or not? Do I need a Meldunek? The official answer is yes, but I was told differing things.

I, too, had to go to the hospital and it was like nothing on earth. Frankly, Poland should not be given the fucking right to be in the EU - you are all fucking peasants. Your food sucks. Your government (and politics generally) is a fucking mess. Your particular brand of Catholicism is anti Catholic - you don't listen to Rome. You idolise your historical figures, but let's face it your last king ran away!!Your roads are shit. Wake up Poland - get a life and stop being proud of your ridiculous history.

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I think this could be a polish issue. My childrens father got a polish doctor here, and shortly after she put her name on the death certificate, she disappeared. I can't find her listed on the AMA's website either.

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